Diabetes Remains a Persistent Epidemic

It doesn’t grab as many headlines as Ebola, the recent measles outbreak, or other infectious diseases, but its reach and impact are certainly far greater. And it’s clear from the numbers that it can’t be considered anything other than an epidemic.
Diabetes in the U.S. has more than tripled over the last three decades, soaring from 5.6 million Americans in 1980 to almost 21 million today, according to the U.S. Centers for Disease Control (CDC). Nearly 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of Americans now have this chronic condition, and for seniors, the percentage is much higher: 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those 65 and older are afflicted.
The situation is even more ominous, however, than those figures suggest.
CDC estimates that another 8 million have diabetes but are undiagnosed, and 86 million more are living with pre-diabetes, with 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those unaware of their condition. If current trends continue, one in three adults in the U.S. will have diabetes by 2050.
The reason for this surge in diabetes is easy to understand: it is directly linked to the rates of obesity, and that’s related to the kinds of foods we eat and the calories in our food. Like diabetes, obesity is epidemic: 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of adults and 17{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of children and adolescents ages 2-19 are obese. Many more are overweight.
Exactly what is diabetes? It is a condition in which the levels of glucose (the sugar formed from the food we eat) in the blood are above normal. Insulin, a hormone produced by the pancreas, helps to move glucose into cells in the body, but with diabetes, the body doesn’t make enough insulin or can’t use what it does have well enough, causing sugar to build up in the blood.
Two main types of diabetes exist. Type 2, mainly a product of poor diet and lifestyle choices, is by far the most common, accounting for 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 95{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of cases. Type 1, about 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all diagnosed cases, occurs when the immune system attacks the cells in the pancreas that make insulin, hindering insulin production. The complications and damage to the body are similar from both types, but they are quite different from each other. (A third type, gestational diabetes, develops in 2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all pregnant women but usually disappears when the pregnancy is over.)
Pre-diabetes is a condition where the levels of blood sugar are higher than normal but below the level for a complete diagnosis. Without lifestyle changes, however, many of these patients will develop Type 2 diabetes within five years.
If not managed properly, diabetes can be dangerous and life-threatening. Complications of the disease can include damage to blood vessels and nerves, blindness, kidney damage, amputations, and cardiovascular disease. The disease is the seventh-leading cause of death in the U.S. and the leading cause of new cases of blindness, kidney failure, and amputations of the feet and legs for adults.
Now here’s the good news: diabetes is preventable and controllable. Everyone should examine their risk factors for this condition, including family history and lifestyle. Eating high-calorie foods, being overweight, and a leading a sedentary lifestyle pose the greatest risks, along with having an immediate family member — parent or sibling — with the condition.
For patients with diabetes, it is critical to pay attention to A1C blood tests. This common blood test measures blood glucose levels over a period of months and is the best marker of how a patient is doing over time in controlling the disease. Knowing A1C levels helps patients focus on the condition and take responsibility for it. It’s also imperative to control blood pressure and cholesterol, major contributors to heart disease — the condition most often related to diabetes.
Diabetes need not be a lifelong burden. It can be managed effectively with a healthy diet, regular exercise, medication, consistent monitoring of glucose levels, and working with a physician, diabetes specialist, or nutritionist. Patients who discover they are pre-diabetic should talk with their physician about the changes needed to improve health and avoid the disease.
For more information on diabetes, pre-diabetes, and programs on prevention, visit the CDC at www.cdc.gov/diabetes. For a video discussion, visit the Mass. Medical Society at www.physicianfocus.org/diabetes2015.
Dr. Michael Thompson is ambulatory physician leader for the Diabetes Center of Excellence at UMass Memorial Health Care and chief of Adult Diabetes Clinical Research at UMass Memorial Medical Center in Worcester. This article is a public service of the Mass. Medical Society.